When a dental prosthesis (e.g. a crown) is cemented onto an implant abutment, cements are typically loaded into the intaglio portion of the crown and placed onto the abutment for fixation. It is not uncommon for excess cement to flow out of the abutment-crown margin. This can require a clinician spending time cleaning around the margin in an attempt to remove any remaining cement particles or remnants. Unfortunately, this cleaning procedure is tedious and time consuming as dental cements, once completely set on metallic and ceramic surfaces such as those of implants and crowns, are difficult to remove. Such excess cement can act as a dental calculus or plaque, which can facilitate the development of peri-implant disease.
Peri-implant disease is defined as an inflammatory reaction of the tissues which surround a dental implant system and is known to result in the destruction of bone tissue, ultimately leading to implant failure (American Academy of Periodontology 2013). Peri-implant mucositis refers to inflammation of soft tissues (gum inflammation) surrounding dental implants without signs of bone loss. If this inflammatory process is not controlled, it can develop into peri-implantitis, which is characterized as bone resorption surrounding the implant. The lack of cement placement technique standardization in cement-retained prostheses procedures has only exacerbated the deleterious effect of residual cement induced peri-implant disease (Wadhwani 2015). Clinicians and dental technicians are typically not trained in the placement of dental cements, or the volume of cements needed for these procedures. Reports indicate that peri-implant mucositis is present in nearly fifty percent of implant procedures between 1 month and 10 years (Fransson et al. 2005; Roos-Jansaker et al. 2006). However, this stage of the disease is reversible with early intervention including the removal of residual cement. The reversal of inflammation following the complete cleaning of residual cement lends itself to the hypothesis that the cement components are the cause of the inflammatory reaction surrounding the implant. The prevalence of peri-implant disease in the United States has been recently reported to be between 28 percent and 50 percent. (Zitzmann and Berglundh 2008). Considering the number of implants used per year (between 100,000 and 300,000), this becomes a significant number of peri-implant cases (Gaviria et al. 2014).
Dental cements for cement-retained restorations are often chosen based on clinician preference for the product's material properties, mixing process, delivery mechanism, or viscosity. It has been recently suggested that the composition of the dental cement can play a significant role in the proliferation or inhibition of different bacterial strains associated with peri-implant disease (Raval et al. 2015; Rodriguez et al. 2016a). The effect of dental cements on host cellular proliferation may provide further insight into appropriate cement material selection. As mentioned, recent literature indicates that the long-term success of dental implants is, in part attributed to how dental crowns are attached to their associated implants (Chaar, Att, and Strub 2011; Ma and Fenton 2015; Wismeijer et al. 2014; Wittneben, Millen, and Bragger 2014). The commonly utilized method for crown attachment—cementation—has been criticized due to recent links between residual cement and peri-implant disease (Wilson 2009; Linkevicius et al. 2011; Linkevicius et al. 2012).
These facts make residual cement extrusion from crown-abutment margins post-crown seating a growing concern in the dental community (Wilson 2009; Linkevicius et al. 2011; Linkevicius et al. 2012). While the mechanism of action of residual cement induced peri-implant disease is still being investigated, recent evidence suggests that dental cement components themselves could initiate an inflammatory reaction (Raval et al. 2015; Rodriguez et al. 2016).
As discussed in further detail below, exemplary embodiments of the present disclosure address shortcomings of existing systems and provide notable benefits in comparison to such systems.